tbuckley/cabot-search huggingface dataset:
Abstract 13057: Efficient Diagnosis and Reduced Medical Costs by the 0-hour/1-hour Algorithm for Patients With Suspected Non ST Elevation Acute Myocardial Infarction in the Emergency Department
Authors: Shun Sasaki, Kenji Inoue, Masayuki Shiozaki, Keigo Handa, Ryo Watanabe, Tohru Minamino
Journal: Circulation (2022)

Background: European Society Cardiology guidelines recommend that the 0-hour/1-hour (0-1h) algorithm using high sensitivity cardiac troponin T (hs-cTnT) improves the early triage of patients with chest pain. To avoid the unnecessary admission including coronary angiography leads to decrease in medical costs. However, the economic consequences of applying the algorithm are unknown. Purpose: We compared the medical expenses to be affected by the implementation of this algorithm. Methods: We compared two prospective cohort study (one hospital has been implemented the 0-1h algorithm (cohort A), and the other has not (cohort B)) using a de-identified electronic medical record based on the database of health claims in Japan. Eligible patients were measured of hs-cTnT because of chest pain. We excluded patients with STEMI, heart failure or terminal kidney function. The 0-1h algorithm stratified patients into “rule-out,” “rule-in,” and “observation” based on the measurements of hs-cTnT levels at baseline and absolute changes at 1hour. Resource utilization (RU) and predicted diagnostic accuracy of the 0-1h algorithm compared to usual care in the emergency department (ED) were estimated. We then assumed that we implemented the 0-1h algorithm in cohort B by applying the diagnostic accuracy of the 0-1h algorithm to cohort B and compared it with the collected data achieved within 30 days of the index visit. Results: Consecutive 472 in cohort A (69.6 +/- 14.1 years old, 59.5% male) and 427 in cohort B (65.8 +/- 14.4 years old, 59.0% male) were followed. The prevalence rates of AMI were 7.4% and 3.3%. The sensitivity and specificity for the 0-1h algorithm in cohort A were 100% (91.1%-100%) and 95.0% (94.3%-95.0%), compared to 92.9% (69.6%-98.7%) and 89.8% (89.0%-90.0%) for usual care in cohort B. Assuming that the 0-1 algorithm is implemented in cohort B with the same diagnostic accuracy, emergency CAG is expected to be reduced by 50%, with a reduction in healthcare costs of approximately $ 1,500 to $ 2,500 per person. As a result, the implementation of the 0-1hr algorithm is expected to reduce medical costs by $ 31,500 to $ 52,500 in cohort B. Conclusions: The 0-1h algorithm dose not only efficiently stratifies risks, but can also be expected to reduce medical costs.
Abstract 13567: Impact of Mavacamten on Artificial Intelligence Electrocardiographic Diagnosis of Hypertrophic Cardiomyopathy in the EXPLORER-HCM Trial
Authors: Konstantinos C Siontis, Joshua P Barrios, Zachi I Attia, Sean A Abreau, Theodore P Abraham, Iacopo Olivotto, Artur Oreziak, Roberto Barriales-Villa, Ahmad Masri, Neal K Lakdawala, Priyanka Agarwal, Aarthi Balasubramanyam, Amy J Sehnert, Paul A Friedman, Jeff E Olgin, Peter A Noseworthy, Geoffrey H Tison
Journal: Circulation (2022)

Introduction: Deep-learning artificial intelligence (AI) algorithms can identify hypertrophic cardiomyopathy (HCM) from the electrocardiogram (ECG). Preliminary data indicate that AI-ECG may also track treatment response in HCM patients (pts) receiving mavacamten (Mava). In this placebo-controlled analysis, we investigated the performance of AI-ECG in HCM detection and its changes during Mava treatment compared to placebo in the phase 3, EXPLORER-HCM trial. Methods: Pts with non-paced ECGs enrolled in EXPLORER-HCM, evaluating Mava over 30 weeks of treatment, were included. All pts had a 12-lead ECG pre-treatment, at each study visit, and 8 weeks after treatment end. Two independently developed AI-ECG convolutional neural network algorithms from the Mayo Clinic and the University of California, San Francisco (UCSF) were applied to all ECGs suitable for analysis. Serial AI-ECG-predicted scores, which correlate with HCM likelihood (range 0-1), were examined between Mava and placebo groups. Results: A total of 101 Mava and 110 placebo pts were included (mean age 58.6, female 40%). At baseline, the mean Mayo and UCSF AI-ECG scores for HCM were 0.82 and 0.65, with 94% and 88% of pts exceeding the respective diagnostic thresholds of 0.11 (Mayo) and 0.4 (UCSF). During 30 weeks of follow-up in the Mava group, the algorithms showed a mean AI-ECG score reduction of 0.32 (Mayo) and 0.17 (UCSF) in all pts between start and end of treatment. In comparison, AI-ECG scores decreased by 0.05 (Mayo) and increased by 0.02 (UCSF) in the placebo group (Mava vs placebo, t-test p-values &lt;0.001 for both algorithms; Figure ) Conclusion: In the EXPLORER-HCM trial population, two independent deep-learning AI-ECG algorithms correctly identified most HCM pts and demonstrated significant reductions in predicted HCM scores after treatment with Mava when compared to placebo. This relative normalization of the ECG suggests disease-modifying properties of Mava, deserving further investigation.
Abstract 13455: Clinical Outcomes of Intravascular Ultrasound During Percutaneous Coronary Intervention- United States Nation-Wide Analysis 2014 Through 2019
Authors: Muhammad Usman, Muhammad Usman Almani, Muhammad Qudrat Ullah, Muhammad Yousuf, Aviral Vij
Journal: Circulation (2022)

Introduction: Intravascular Ultrasound (IVUS) is a catheter-based real-time imaging procedure that assists in both diagnosis and treatment during Percutaneous Coronary Intervention (PCI). Over the years, IVUS-guided PCI have become more popular. In this study, we aimed to analyze the trends of use of IVUS-guided PCI, adjusted in-hospital mortality, hospital length of stay (LOS) and inpatient cost over the years. Methods: Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without IVUS in adult patients (age ≥ 18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of IVUS during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. Results: Of 2,871,865 PCIs in 2014 through 2019, 201,075 (7.0%) were coupled with IVUS. The use of IVUS during PCI steadily increased from 6.2% in 2014 to 9.3% in 2019 (trend p&lt;0.001). The adjusted in-hospital mortality and inpatient LOS for PCI with IVUS showed statistically insignificant trend of higher mortality (1.3% in 2014 vs. 1.6% in 2019, trend p=0.053) and shorter LOS (3.2 days in 2014 vs. 3.0 days in 2019, trend p=0.148). The mean adjusted cost steadily increased over the years for patients undergoing PCI with IVUS (24236$ in 2014 vs. 28700$ in 2019, trend p=0.012). Conclusions: There is a steady rise in use of IVUS during PCI. There is a steady hike in hospital costs for PCI with IVUS hospitalizations however in-hospital mortality and LOS remain the same.
Abstract 12967: Early Gastrointestinal Bleeding is Most Common Hemorrhagic Complication After Watchman Implantation
Authors: Ato Howard, Jill Germinaro, Joseph Squire, Saurabh Sanon, George Jabbour, Madhurmeet Singh, Andrew Voigt, Suresh Mulukutla, Samir Saba, Sandeep Jain
Journal: Circulation (2022)

Introduction: Left atrial appendage occlusion (LAAO) with the Watchman device is increasingly used for patients with an indication for anticoagulation for atrial fibrillation (AF) and a contraindication to long term anticoagulation. Real world early outcomes in this high-risk patient population are scarce. Methods: We retrospectively evaluated a healthcare system registry of 1200 patients who underwent LAAO with Watchman 2.5 or FLX between 10/2018 and 8/2021 and included 849 patients with 6-month follow-up. We classified complications in 3 distinct categories (immediate procedural, 6-week post-procedural and 6-month post-procedural) and tracked all thromboembolism, hemorrhage and mortality that occurred after the immediate procedural complications. Results: Mean age was 77.6 ± 8.3 years old, 49% were female, 68% had paroxysmal AF, mean CHA 2 DS 2 -VASc was 5.0 ± 1.4, and mean HAS-BLED was 2.9 ± 1.0. Immediate procedural complication rate was 2.4% (access site n=16; tamponade n=2; esophageal injury n=2). 6-week post-procedural complication rate was 4.2% whereas 6-month post-procedural complication rate was 2.0% (% per 100 patient-months). Overall post-procedural complication rate after 6.2 ± 1.1 months was 2.6% of which 0.3% were thromboembolic, 1.2% were hemorrhagic and 1.1% were mortality events (% per 100 patient-months). Gastrointestinal bleeding (GIB) made up 39% and 83% of post-procedural and hemorrhagic complications respectively. Time-indexed post-procedural GIB rate was higher during 6-week period compared to 6-month period (1.9% vs. 0.7%, p=0.00003). Patients with most common indication for LAAO (high risk for bleeding or history of major bleeding, 82.0%) had higher odds of post-procedural GIB than those without bleeding indication (7.0% vs. 2.6%, OR=2.8, p=0.02). GIB was not significantly associated with mortality. Conclusions: Post-LAAO complication rate was low and decreased over time when comparing 6-week and 6-month periods in a high-risk patient population. Early GIB was the most common hemorrhagic complication and patients with bleeding indication for LAAO had a higher risk of GIB within the first 6 months after procedure. Further studies targeting ideal antithrombotic regimen after Watchman implantation are needed.
Abstract 13203: Cardiovascular Health in Cardiac Rehabilitation: Applying the American Heart Association Life's Simple 7 in a Center-Based Cohort
Authors: Audry Chacin Suarez, LaPrincess Brewer, Helayna M Abraham, Thomas P Olson
Journal: Circulation (2022)

Introduction: Cardiac rehabilitation (CR) is a comprehensive secondary cardiovascular disease (CVD) program which integrates structured lifestyle interventions to reduce morbidity and mortality. The Life’s Simple 7 (LS7) is an objective measure of cardiovascular health (CVH) which incorporates health-promoting behaviors and clinical factors however, it has not been rigorously evaluated in the CR setting. Methods: Retrospective cohort study of 937 patients who attended center-based CR at Mayo Clinic from Jan 2018 -Sept 2020. Patient characteristics and LS7 component metrics at baseline (pre-CR) and completion (post-CR) were collected: 3 clinical factors (blood pressure [BP], cholesterol, and hemoglobin A1c [HbA1c]), and 4 health behaviors (smoking, body mass index [BMI], physical activity [PA] and diet). LS7 score was computed as a composite of each LS7 component by assigning 2-points for ideal, 1-point for intermediate, or 0-points for poor CVH ranging from 0-14 points. LS7 score was further categorized as poor 0-6, intermediate 7-8 and ideal 9 -14. Results: Patients were 64±13 years old, 34% were female, and attended a mean of 11±12 CR sessions, Table 1. At baseline, the LS7 components with the highest proportion within the poor category were HbA1c (201/495, 41%) and BMI (465/936, 50%), Table 2. From pre to post-CR, there was a reduction in proportion of patients classified within the poor category for each LS7 component except HbA1c ( Figure 1 ), and the proportion of patients with LS7 scores in the ideal range increased from 6.4% to 19% (P&lt;0.001). There was a statistically significant improvement in LS7 score from 5.5±1.8 to 6.7± 2.4 (+Δ1.6±2.4, P&lt;.0001), Table 2 . Conclusions: Patients attending CR demonstrated an improvement in LS7 score and almost all LS7 components suggesting an overall positive impact of CR on CVH. Further research is needed to better understand the impact of the individual LS7 components on CV outcomes in diverse populations participating in CR.
Abstract 12932: Should We Screen For Radiotherapy-Induced Heart Disease With Exercise Stress Echocardiography? Emphasis on Major Adverse Cardiac Events
Authors: Rafael Toro-Manotas, Renzo Mogollon, Mariana Garcia-Arango, Bryan Vallejo, Jamie L Carroll, Jenna Hoppenworth, Lori Thicke, Deanne D Smith, Christine L Klassen, Tufia Haddad, Prema P Peethambaram, Robert Mutter, Daniela Stan, Hector R Villarraga
Journal: Circulation (2022)

Introduction: Exercise Stress Echocardiography (ESE) is recommended as a screening tool for the evaluation of Coronary Artery Disease (CAD) in patients with suspected Radiation-Induced Heart Disease (RIHD). Up to now, studies have only evaluated its association with the extent of CAD. Hypothesis Cancer survivors treated with chest Radiotherapy (RT) that undergo an ESE and have a +ESE develop more MACE than those who have -ESE. Methods: A retrospective, descriptive, cohort study was conducted. Patients who had chest RT and underwent ESE with Treadmill Bruce Stress Protocol, from 2000 to 2012, at Mayo Clinic Rochester and Mayo Clinic Health System were included. A univariate analysis was performed to characterize the population. An analysis including Kruskal Wallis and Pearson Chi-Squared tests was completed to identify variables associated with + SE (Table 1). Multivariable Cox Model for MACE was conducted and is shown in Table 2. A time-to-event curve using Kaplan-Meier estimates is shown in Figure 1. Results: We identified 113 patients, with a mean age of 67 years and a median follow-up of 15.1 years. Of those, 99% were female, 98% were breast cancer survivors, 59% had HTN, 14% DM, 11% AFib, 2% COPD, and 12% had a history of MI. All the patients received &gt;3000cGy of Photon RT, and 57% were treated with systemic cancer therapies. A +ESE was seen in 20.3% of the patients with no significant difference in METS achieved compared with patients who had a -ESE. COPD, RT dose, and systemic therapies, specifically doxorubicin, were associated with a +ESE. The cumulative incidence of MACE was higher in the group of +ESE (p=0.029). After adjustment for HTN, DM, smoking history, hyperlipidemia, and prior MI, the HR for MACE associated with a +ESE was 1.97 (1.09-3.59). Conclusion: MACE was more frequent in patients with a +ESE who received chest RT and doxorubicin versus -ESE. These results support the usefulness of ESE in cancer survivors after RT as a cardiovascular screening tool.
Abstract 13774: Association Between Baseline Heart Failure During Acute Coronary Syndrome and Long-Term Cancer Risk. The ABC-9* Study on Heart Disease
Authors: Heba T Mahmoud, Rocco Cordiano, Fiorella Cavuto, Francesco Bagato, Stefania Petucco, Mattia Pasquinucci, moemen mohammed M mahmoud, Nadir Sitta, Tobia Nardi, Giuseppe S Berton
Journal: Circulation (2022)

Introduction: We aim to investigate the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the long-term cancer risk. Methods: This prospective study included 571 patients admitted to 3 Italian hospitals and with ACS discharged alive and free from cancer. They were followed for 24 years or until death. Results: All except for three patients completed the follow-up, representing 6416 person-years. Patients' mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow-up, 129 patients (23%) developed cancer; of them, 103 with no HF [27% of patients without HF] and 26 had baseline HF [14% of patients with HF].The incidence rates for cancer were 21 and 18 per 1000 person-years for patients without and with baseline HF, respectively (p = 0.61).The risks for cancer associated with HF were (HR: 0.96; 95% CI: 0.62-1.47; p=0.84). Similar associations were observed among men, women, and patients younger than 75 years of age. Yet, in patients older than 75 years the unadjusted risk was (HR: 0.30; 95% CI: 0.09-0.92; p=0.04). Although, the fully adjusted risk was (HR: 0.39; 95% CI: 0.12-1.30; p=0.13). The unadjusted HRs for cancer development were (HR: 0.88; 95% CI: 0.45-1.74; p=0.73) and (HR: 0.91; 95% CI: 0.48-1.71; p=0.77) for patient with HFrEF and HFpEF respectively.We observed a positive interaction between age and LVEF for the risk of cancer onset (HR: 1.002; 95% CI: 1.0003 -1.004; p=0.02) in the unadjusted model. Results were the same in fully adjusted model. Conclusions: This prospective study of unselected ACS patients showed a lack of association between clinical heart failure at admission for ACS and the long-term cancer risk. A positive independent interaction between age and LVEF for the long-term risk of cancer was also observed. Figure 1: Cumulative hazards of cancer according to HF status (A) and interaction between age and LVEF for the risk of cancer (B) 24-years after ACS.
Abstract 13255: Variation in the Use of Therapeutic Hypothermia for Cardiac Arrest
Authors: Jonathan D Wolfe, Erika Fanous, RJ Waken, Daniel Fox, Karen E Joynt Maddox
Journal: Circulation (2022)

Introduction: Therapeutic hypothermia is a guideline-recommended treatment for certain unresponsive patients after a cardiac arrest. However, the degree to which patients with cardiac arrest have access to this therapy on a national level is unknown. Understanding hospital- and patient-level factors associated with receipt of hypothermia could inform interventions to improve access to this treatment among appropriate patients. Methods: This was a retrospective analysis using National Inpatient Sample data from 2016-2019. We used ICD10 diagnosis and procedure codes to identify adult patients with in-hospital and out-of-hospital cardiac arrest and receipt of therapeutic hypothermia. We used logistic regression with GEE clustering on hospital-year, and controlling for medical comorbidities, to evaluate patient and hospital factors associated with receiving therapeutic hypothermia. Results: We identified 478,419 patients (unweighted) with cardiac arrest. Of those, 4088 (0.85%) received therapeutic hypothermia. There was significant regional variation in hypothermia capabilities (Figure 1). At the patient level, age &gt; 74 (OR: 0.54, p&lt;0.001), female gender (OR: 0.89, p&gt;0.001) and Hispanic race (OR: 0.69, p&lt;0.001) were all associated with decreased odds of receiving hypothermia. Compared to patients with private insurance, patients with Medicare (OR: 0.73, p&lt;0.001) and Medicaid (OR: 0.88, p=0.013) were less likely to receive hypothermia. Patients with shockable rhythms were less likely to receive hypothermia than those with non-shockable rhythms (OR: 0.85, p&lt;0.001). Conclusions: Therapeutic hypothermia is rarely utilized after cardiac arrest and there is substantial regional variation in its use. Advanced age, female gender, Hispanic race, Medicare or Medicaid insurance, and shockable rhythm are all associated with a decreased likelihood of receiving hypothermia.
Abstract 13334: Whole Blood Multi-Omic Characterization of the ISCHEMIA Cohort Reveals Vulnerable and Resilient Subtypes of Chronic Coronary Disease
Authors: Macintosh G Cornwell, Ze Chen, Iftikhar J Kullo, Bruce M McManus, L Kristin K Newby, Claes Held, Sripal Bangalore, David J Maron, Judith S Hochman, Harmony R Reynolds, Jeffrey S Berger, Jonathan D Newman, Kelly V Ruggles
Journal: Circulation (2022)

Introduction: Chronic coronary disease (CCD) is a leading cause of death worldwide. Whole blood (WB) transcriptomic (RNA-seq) and methylation ‘omics’ data can discern molecular underpinnings of CCD and create molecular subtypes to aid risk prediction. Methods: Of 1,064 participants with moderate-severe ischemia (Age: 67.1±6.2, 19.4% Female, 17% non-White) from the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) biorepository, 646 participants had available WB RNA-seq and 737 had WB methylation data ( Fig 1A ). Unsupervised clustering and differential analyses identified omics-derived molecular subtypes. We identified co-regulated gene modules of each subtype, performed subtype-level enrichment of clinical variables, and performed Kaplan-Meier analyses for time to cardiovascular (CV) death or myocardial infarction (MI). Results: Multi-omic analysis revealed 4 RNA-seq-derived subtypes (RS) and 3 methylation-derived subtypes (MS). RNA-seq Subtype 1 (RS1) was enriched for molecular drivers indicative of an adaptive immune response, had clinical enrichment of female sex, statin use, and greater ischemia, and had decreased risk of CV death or MI ( Fig 1B ). RNA-seq Subtype 2 (RS2) was enriched for innate immune response pathway, and patients who were older and White, and was associated with increased risk of CV death or MI. Similarly, methylation subtypes also yielded a high-risk subtype (MS3) and a low-risk subtype (MS2) ( Fig 1C ). Integration of transcriptomic and methylomic subtypes led to further distinction of resilient and vulnerable subgroups. Conclusions: WB RNA-seq and methylation data identified molecularly-defined subtypes that informed the underlying disease pathology of CCD patients in ISCHEMIA. These subgroups were differentially enriched for clinical characteristics and event outcomes, demonstrating the potential use for blood-based omics tests to aid in the prognosis of CCD.
Abstract 14300: Arterial Stiffness is Associated With Intermediate-Term Home Blood Pressure Variability: The Electronic Framingham Heart Study
Authors: Xuzhi Wang, Yuankai Zhang, Chathurangi H Pathiravasan, Honghuang Lin, Belinda Borrelli, Nicole L Spartano, Emelia J Benjamin, David D McManus, Martin Larson, Vasan S Ramachandran, Naomi M Hamburg, JoAnne Murabito, Chunyu Liu, Gary F Mitchell
Journal: Circulation (2022)

Introduction: Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies examined associations between arterial stiffness and digital home BPV over an intermediate time span. Objective: We investigated if antecedent arterial stiffness was associated with home BPV among participants in the electronic Framingham Heart Study (eFHS). We hypothesize that higher arterial stiffness predicts higher intermediate-term home BPV over one-year follow-up. Methods: At an FHS research exam (2016-2019), participants underwent arterial tonometry to acquire mean arterial pressure (MAP) and measures of arterial stiffness (carotid femoral pulse wave velocity, CFPWV; forward pressure wave amplitude, FWA) and wave reflection (reflection coefficient, RC). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly. Participants with &lt; 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with home average real variability (ARV) of systolic (SBP) and diastolic (DBP) BP adjusting for covariates. We obtained ARV as an average of the absolute differences of consecutive BP measurements. ARV considers not only the dispersion of the BP readings around the mean, but also the order of BP readings. We used p&lt;0.05 for significance. Results: Among 857 eFHS participants (mean age 54 years, 59% women, mean BP 119/76, 47% hypertension, mean ARV of DBP 5.50, mean ARV of SBP 8.61), higher FWA and RC were associated with higher ARV of SBP ( Table ). Higher CFPWV was associated with lower ARV of DBP ( Table ). Conclusion: In eFHS, higher FWA and RC were associated with higher intermediate-term home BPV of SBP while higher CFPWV was associated with blunted BPV of DBP. Our findings suggest that higher aortic stiffness and wave reflection may affect day-to-day modulation of blood pressure in a home-based setting.